1. Focus International News TV BS Taiwan*.
Best practice management inBest practice management in
emergency medicineemergency medicine –– latest approach.latest approach.
>350 patients/day>350 patients/day
May 20 2014
Michael Hansen-Nord, MD, Head of Department
Odense University Hospital, Denmark

2. We have to deal with
1. Overcrowding
2. Staff
1. Stress
2. High % of absence
1. 8 – 10 %
3.

3. Patients in ED, OUH
127.000
(350/day)
60.000
Emergency services
(7 hours daily)
40.000Somatic fast-track
27.000
Triage (admittance?)
(2/3 of all)
Patients/year
(average)
Categories

4. Identify paradigmes..
1. Consultant in front
2. Standardization
3. Do things on time .. Don't pros pone
4. Diagnostic packages
1. standardization
5. 4 hours to diagnose
6. Synergy by performers
7. M.fl.

5. Challenges?
1. Standardization
1. Processes
2. Logistics
3. Professional approach

6. Standardization
1. Processes

7. EmergencyEmergency
service.service.
Admittance?Admittance?
Fast trackFast track
Blue patientsBlue patients
Cut down to 3 different tracks

8. CompetencesProcestimeProcesses ”green”
180Waiting time
consultant30Evaluation
X-ray and lab.360Answers on diagnostics
Resident90Medical record
Skilled nurse10Triage
Nurse15In-bed procedures
Secretary5Pre visitation
Secretary5Registration
11,5 timer

9. Keep the patients in flow
1. 4 hours stay in ED
2. All acute diagnostics should be at
hand before the patient leaves the
ETC.
3. Introducing TRIAGE (ADAPT) for all
patients.
4. 70 % discharged < 48 timer

10. The challenge…!
1. Passing time in ED 4 hours.
1. 14 – 18 staff members needed
2. > 85 % of the patients are yellow or green in
triage
1. They do not need immediate action
2. …but they should be kept in flow also

12. Triage - ADAPT
Red
Orange
Green
Yellow
Rescusation
Blue

13. Admittance ?
160
Nurse2 eller 515Initial nursing
Nurse2 eller 510Stafet
Internist245Patients file
Senior doctor215Senior doctors evaluation
4Waiting area
Radiologist315Radiology
Lab. technician215Blood-analysis
Nurse and senior doctor220Triage and visitation
Nurse215In bed
Nurse15Previsitation
Secretary15Registration
240Total minutes in the acute area
Staff … competencesLocationMinutesTime pr. process

15. Simulation options?
Staffing
First edition of standardized, process-driving
patient tracks
Variations over the day/month/year
Bottlenecks?
Chaos-handling

16. Standardization
1. Logistics

18. Conference

19. Conference

20. Logistics in ED

21. Logistics in ED
Who's next?

22. Logistics in ED
How fare are we?

23. Logistics in ED
Time from arrival – to meet the 4 hour criteria?

24. Standardization
1. Professional approach

25. Incoming patients
1. We don't know them by diagnose
1. ..do you?
2. ..but we know them by symptoms
1. 34 somatic symptoms (97%)
2. 5 psychiatric symptoms

26. From diagnose- to symptom
based visitation
1. Visitation by suspected diagnose
1. Obs. MI
2. Obs. Appendicitic
3. Etc.
2. Visitation based on symptoms combined
by triage-color
1. Chest-pain and red
2. Abdominal pain and orange
3. Etc.

27. Diagnostic packages (DP)
in the region of Southern Denmark
1. 34 somatic DP and 5 psychiatric
2. Recipe on what professional output a sudden
somatic symptom must provoke
1. Blood samples
2. Radiology
3. Part of the triage-process

28. Yes – we perform!
1. ½-hour criterion
1. Average 41 minutes
2. 4- hour criterion
1. Average 3 hours 51 minutes
3. Not admitted?
1. 60 to 75 %
4. Average admittance in ED?
1. 18 to 13 hours

29. Thank You for Your attention
Michael Hansen-Nord
michael.hansen-nord@rsyd.dk